AIIMS imbroglio

AIIMS Director P. Venugopal in his office on July 8 after the Delhi high Court stayed his removal. - R.V. MOORTHY

The apparent erosion of the AIIMS' autonomy has been brought centre stage by the decision to terminate the tenure of its Director.

THE resolution passed on July 5 by the Institute Body of the All India Institute of Medical Sciences (AIIMS) recommending the termination of the tenure of its Director P. Venugopal has generated a huge controversy and sparked off a debate. The cardio-thoracic surgeon immediately filed a petition in the Delhi High Court challenging the decision. After a hearing on July 7, the court stayed the recommendation and posted subsequent hearings for August 17.

Venugopal was appointed Director on July 3, 2003, through a somewhat curiously phrased notification of the Ministry of Health and Family Welfare, "for a period of five years from the date he assumes charge of the post and until further orders" (emphasis added). In fact there is an ongoing case where his appointment has been challenged through a public interest petition on the grounds that he was barely a year away from the age of superannuation at 62. Interestingly, this case comes up for hearing on July 17. Venugopal was appointed during the National Democratic Alliance (NDA) regime when Sushma Swaraj was the Health Minister.

A premier institution for clinical services and medical education and research, the AIIMS was established as an "institution of national importance" by an Act of Parliament, the AIIMS Act of 1956, and was founded by Rajkumari Amrit Kaur, who was Union Health Minister then.

In his petition, Venugopal prayed that the decision to terminate his tenure prematurely was illegal and mala fide and, therefore, deserved to be quashed. He contended that Union Health Minister Anbumani Ramadoss had announced the decision publicly and that he was not given a copy of the resolution or the decision seeking his removal. He urged the court to call for the record of the meeting that took the decision.

Venugopal submitted that the objective of Parliament in establishing "institutions of national importance" was to confer autonomy and eliminate the possibility of political interference and red-tapism. The amendment to the AIIMS Act made on August 25, 2000, the petition contended, provided the legislative mandate in this regard.

The petition argued that the nomination of the Minister as a member and president of the Institute Body, in apparent contravention to this amendment, had led to interference by the Minister in the institute's affairs, which undermined its autonomy greatly. It also sought disqualification of the Minister's membership to the Body on the grounds that the office of the president was an office of profit.

The Act empowers the 17-member Institute Body to appoint the Director or terminate his/her term of office in public interest. For termination of services before the expiry of the term, a notice period of not less than three months or three months' salary and allowances in lieu thereof is sufficient. The petition said neither was the Director given any notice nor were any justifiable grounds provided for his removal.

The Assistant Solicitor-General, arguing for the government during the July 7 hearing, justified the Director's removal by stating that he had failed miserably in effectively administering the institute. Two representations from the institute faculty and the fact that two senior professors had resigned on account of acts attributable to the Director formed the basis of the argument. Further, it was argued that the Director, by criticising the government during the recent anti-reservation strike, had violated Conduct Rules.

However, the ruling Judge found that prima facie the material submitted were insufficient to justify the action. But, more pertinently, the Judge pointed out that the agenda put up before the meeting of the Institute Body on July 5 did not refer to any administrative failure of the Director but only said that he had violated Conduct Rules by criticising the government.

The note circulated at the meeting of the Body, according to the Judge, included the text of Venugopal's address to the faculty and students during the strike. In this he spoke of "the destruction of the dignity and autonomy of AIIMS" by the government and averred that during the past two years there had been a systematic undermining of the institute and the authority of its Director.

The Judge, while ordering the stay, observed that if the removal was on account of violation of Conduct Rules, "the petitioner ought to have been given a reasonable hearing before taking a decision... . No notice had been given to the petitioner nor any material forming basis of allegation of his criticism of the government was given to him. No hearing has been given to him and even before the governing [sic] body it seems no such material had been produced which could be the basis for forming such an opinion... . In the circumstances, the petitioner has been able to make out a prima facie case that termination of his tenure post is vitiated under law... . The inevitable inference in the facts and circumstances is that the balance of convenience is in favour of the petitioner."

Venugopal's case has brought to the centre stage the issue of apparent erosion of the autonomy of autonomous institutions under various Central Ministries. While whether the question of autonomy is the key issue in the present context is debatable, the issue nevertheless merits discussion. Many in the scientific community would argue that as long as the institution is dependent on funds from the government as grants-in-aid, autonomy in the liberal sense of the term does not exist.

There is no definition or even an operational description of what is meant by autonomy with regard to autonomous institutions under the government. There is a perceived sense of the term, which is quite ill-defined and nebulous. But there is operational autonomy that is quite removed from the former and which varies from institution to institution. There are degrees of autonomy depending upon whether it is a university, a society or establishment under a trust or formed under acts of Parliament; whether it is a purely academic one, a research and development institution, a service-oriented institution or a combination of these. Only in cases where the institution is dependent on the government for project-based funding, the difference between perception and operation of autonomy is perhaps the least, points out a senior government functionary associated with science administration.

The unfortunate thing about autonomous institutions in the Indian context is that the institutional autonomy often gets reduced to the autonomy of the individual at the top and the coterie around that individual. The merits of autonomy do not percolate to the lower levels. There is extreme reluctance at the top to delegate powers so that the working scientists can dwell on academics and research more effectively and efficiently. They are faced with several internal walls, including in such matters as purchase procedures and the freedom to express one's opinions on scientific matters and the functioning of the institution.

Autonomy also becomes a convenient tool for manoeuvring by the higher-ups through the political system and the bureaucracy to further their interests. The institution then becomes a fertile arena for the bureaucracy to exercise its powers. And since the bureaucracy is closer to the political system, it prevails. The increasing interference of the Department of Personnel and Training (DoPT) and the Appointment Committee to the Cabinet (ACC) is evidence of this. They have begun to exercise increasing control in senior executive appointments since the controversy surrounding the Indian Council for Social Sciences Research (ICSSR) in 2001. A change of regime begins to have a bearing on this process as was seen in the appointment of Directors of various autonomous institutions, including the Indian Institutes of Technology, during the NDA regime and the subsequent `detoxification' process. The latest move of the ACC, a notification on July 3 to all autonomous institutions that it will have a say in the selection committees for higher-level appointment, is a further consolidation of this process.

"The extent of functional autonomy also depends a great deal on the kind of no-non-sense leadership that institutions have had and conventions established over the years," points out Dr. M.S. Valiathan, the cardiac surgeon who was recently appointed to head a four-member AIIMS Review Committee constituted by the Health Minister, the terms of reference of which, significantly, include the issue of AIIMS autonomy. Valiathan was associated with the setting up of Sree Chitra Tirunal Institute of Medical Science and Technology, an autonomous institution in Thiruvananthapuram set up under an Act of Parliament in 1980 under the Ministry of Science and Technology of which he was the first Director as well. The Sree Chitra Act was modelled on the lines of the AIIMS Act and the Post-graduate Institute of Medical Education and Research (PGI), Chandigarh, Act of 1966. Yet unlike in the case of AIIMS or even the PGI, the involvement of the Minister or even the bureaucracy in Sree Chitra is minimal.

Any change in the statute or structure of the three institutions requires an amendment to the Act and thus the involvement of the political system. To that extent, the autonomy enjoyed by such institutions would be only to the extent of academic freedom and day-to-day affairs of the institutions.

Take the case of the AIIMS. The president of the AIIMS (as in the case of the PGI and Sree Chitra) is nominated by the Central government from among the members, other than the Director, of the Institute Body. Further, the Act stipulates that the President of the institute shall also be the Chairman of the Governing Body of the AIIMS, that is, the same person heads both the Institute Body and the Governing Body. In the case of the AIIMS this happens to be the Union Health Minister because, although not required under the Act, it has been customary ever since its founding by Amrit Kaur for the government to nominate the Minister the Institute Body's President.

However, there have been two exceptions: one during the Janata Party-led government in the late 1970s and the other during the Chandra Shekhar government. The practice has continued even after the amendment to the Act in 2000, which Venugopal's petition contended is illegal.

The composition of the Institute Body follows from Section 4 (a-g) of the Act, which states that the institute shall consist of the following members, namely: (a) the Vice-Chancellor of Delhi University, Delhi, ex-officio; (b) the Director-General of Health Services, Government of India, ex-officio; (c) the Director of the institute, ex-officio; (d) two representatives of the Central government to be nominated by the government, one from the Ministry of Finance and one from the Ministry of Education (now Human Resource Development); (e) five persons of whom one shall be a non-medical scientist representing the Indian Science Congress Association; (f) four representatives of the medical faculties of Indian universities to be nominated by the Central government in the manner prescribed by the rules; and, (g) three Members of Parliament of whom two shall be elected from among themselves by the members of the House of the People and one from among themselves by the members of the Council of States.

Besides the above, 4(e) and 4(g) provide respectively for five persons, including one non-medical scientist representing the Indian Science Congress Association, to be nominated by the government and three Members of Parliament of whom two would be elected from the Lok Sabha and one from the Rajya Sabha.

The amendment relates to the terms of office (Section 6) with regard to the MPs and states that in the event of their becoming a Minister, a Minister of State or a Deputy Minister or the Speaker or Deputy Speaker of the Lok Sabha or Deputy Chairman of the Rajya Sabha they shall cease to be members of the body. But, despite the amendment, the government has continued to exercise political control by nominating the Health Minister under 4(e) rather than 4(g). It is this apparent contradiction that gives rise to the legal conundrum and is likely to form a significant element in the hearings on the Venugopal case.

In the interpretation of the government, nomination of the Minister under 4(e) does not militate against the spirit of the amendment whereas according to the petition it does when 4(e) is read harmoniously with 4(g) and the spirit of the Act as a whole. Until 2000, there was no such conflict because the apex court had ruled in 1996 that the Minister and the Secretary could be nominated as members under 4(e). Significantly, the court had observed:

"The government, while enacting the Act, appears to have intended to preserve the autonomy of AIIMS, and also to have a say in its management. Under those circumstances, the government appears to have nominated the Minister... and the Secretary... so that in the ultimate management of the supreme body constituted under the Act, the government will also protect the interests of the institution. Otherwise it would appear that the government does not seem to have say or control in the management of AIIMS... [F]rom the point of view of the importance of the institution and public interest... the Central government is justified to nominate [the Minister and the Secretary]. However, there should not be any undue interference by the government in the autonomous management of AIIMS... "

But the flip side of this, particularly in the case of the AIIMS, has been that, over the years, owing to the proximity of successive directors to the political system, especially because VVIPs invariably go to the AIIMS for medical treatment, the institution's autonomy has been allowed to be eroded gradually and the institution rendered vulnerable to political interference at various levels. It is pertinent to point out that Sree Chitra also provides public health care but has remained insulated from the political system perhaps because it is located deep down south, far from the national capital.

What is surprising, however, is that the issue of autonomy and the `save AIIMS' cry are being raised only now. For example, the issue of appointment of the Minister was never raised since 2000 when the amendment came into being. Only now, when there is a crisis at the top, has it become an issue. Also, the Director's term was terminated twice in the past by the decision of the Institute Body.

Indeed, the manner of appointment of Venugopal itself was largely perceived as political. So the crisis in the AIIMS, although portrayed as a fallout of management failure, cannot be separated from the coalition politics, including the reservation policy. The statement by Anbhumani Ramadoss that the move has the backing of the Prime Minister's Office should be seen in this light.

The move is a direct fallout of the 17-day anti-reservation agitation at the AIIMS. The political system perceives the institute's administration as not only having failed to prevent the agitation but having supported it.

Indeed, the institute's Medico Forum for Equal Opportunities, an association of AIIMS students and faculty supporting the reservation policy, which made several representations to the Ministry against the administration for disallowing its members to discharge their duties during the period of agitation, said the following in a recent release:

"That the battle lines (both within and outside the institute) are drawn between the same forces who stood opposed to and in favour of `reservation policy' is a clear indicator that the present tug of war is just an extension of the challenge mounted against the constitutional provision for reservation. That this has been lost sight of by almost all the political parties is a dangerous portent for SCs, STs and OBCs."

This has obvious reference to the removal and appointment in the institute of other senior staff. The attempt by the political system to bring about a change in leadership in the AIIMS has all the characteristics of retaliation against an institution - notwithstanding the autonomy endowed to it by a parliamentary Act - that is seen to have openly rejected a government policy apparently evolved in public interest.